Antiemetics Flashcards
(42 cards)
What are the 3 mechanisms of Glucocorticoids?
- Anti-inflammatory effects
- Direct central action at the solitary tract nucleus
- Interaction with the neurotransmitter serotonin, receptor proteins tachykinin (NK-1 & NK-2, alpha-adrenaline, prostaglandins)
Where does 1/3 of aspiration occur
1/3 occurs during laryngoscopy & intubation
1/3 occurs during the procedure
1/3 occurs during extubation
What is the volume that determines aspiration pneumonitis
15 - 25 mLs
What is the #1 thing patients complain about after surgery?
- emesis
- gagging on the ETT during extubation
- pain
- intraoperative recall
True or False: if your patient experiences nausea or has emesis within 24 hrs of a surgical procedure that required anesthesia, your patient was considered “under anesthesia”
True
What is the most important complaint following surgery & the leading cause of unanticipated hospital admissions following outpatient surgery
PONV
- along with pain
Where is the vomiting center found?
Lies in the nucleus tractus solitarus within the medulla & parts of the reticular formation
The vomiting center receives sensory input from what three locations:
- Chemoreceptor trigger zone (CTZ)
- Vestibular apparatus
- GI tract
How does the CTZ receive noxious stimuli ?
It detects noxious chemical in the bloodstream because it is outside the BBB
Once the vomiting center is activated how is the signal transmitted?
Efferent signals travel via CN. V, VII, IX, X, & sometimes XII through the vagal parasympathetic fibers & sympathetic chain to skeletal m. through alpha motor neurons
True or False: Treating PONV is easier than preventing it.
False.
It is easier to prevent PONV than actually treating it.
- this is completely the anesthesia role
What are the most common patient risk factors for PONV?
- Female
- Non-smoker
- Hx of motion sickness
- Previous PONV
- Youth > elderly
What are 5 anesthetic risk factors for PONV?
- Halogenated agents
- N2O
- Opioids
- Etomidate
- Neostigmine
- Also the longer the procedure the > the risk
- Laparotomies, GYN, & Laparoscopic procedures
Why do women have an increased risk of PONV?
Progesterone & estrogen in the CTZ or on the vomiting center itself
- PONV varies within the menstrual cycle & is reduced after menopause
When should you give Decadron and why?
Give during induction once the patient is asleep b/c it will feel like their genitals are on fire
(even though the text says to give 1 hr prior to anesthesia)
When might you see an increase in blood glucose after giving decadron?
6-12 hrs post-op
When should you administer zofran?
Ondansetron 4mg should be given 30 minutes of the case finishing up
When is Zofran not effective?
Serotonin receptor antagonists are NOT effective in the treatment of motion-induced nausea & vomiting
What is the gold standard antiemetic?
(Ondansetron) Zofran
If you give the higher dose of Zofran what can happen?
QT prolongation & Torsades de pointes
If you combine Zofran with Decadron & Emend what will happen?
the efficacy increases
= Synergistic effect
Neurokinin-1 receptor antagonists
(Emend) Aprepitant
(Emend) Fosaprepitant = pro-drug
(Akynzeo) Netupitant
(Varubi) Rolapitant (P/NK-1 receptor antagonists)
- Work if your patient has a hx of emesis & motion sickness
What are the common side effects of scopolamine?
- Blurred vision
- Dizziness
- Dry mouth
What is the only drug used for gastroparesis?
(Metoclopramide) Regalan
- gastrointestinal prokinetic drug that increases lower esophageal sphincter tone & stimulates motility
